Colon Surgery Linked to High Readmission Rates

FRIDAY Nov. 18, 2011 -- Although one in four patients ends up back in the hospital within three months of colon surgery, new research reveals these readmissions -- which cost $300 million every year -- are often preventable.

The most common reason colorectal surgery patients return to the hospital: complications from surgical-site infections, according to the study published in the December issue of the journal Diseases of the Colon & Rectum. The researchers said many of these infections could be avoided.

"Readmissions after surgery are common and they burden the health care system with exorbitant costs," study senior author Dr. Martin Makary, an associate professor of surgery at Johns Hopkins University School of Medicine, said in a Hopkins news release. "While readmissions are sometimes unavoidable, many times they result from poor coordination of medical care. Everyone knows you can't get readmissions down to zero but, at 23 percent, there's a huge amount of room for improvement. There is no reason we can't cut that rate in half."

The cost is roughly $9,000 every time a patient is readmitted, the study found.

"Hospital readmissions are costly to the patient, costly to the system, delay recovery and victimize some patients multiple times," study leader Dr. Elizabeth Wick, an assistant professor of surgery, said in the news release.

In conducting the study, researchers analyzed the records of nearly 11,000 patients who underwent colorectal surgery over the course of six years. They found that within one month of being discharged, more than 11 percent of patients were readmitted to the hospital. Another 12 percent were readmitted at between one and three months. The study also revealed that nearly 7 percent of the patients were readmitted two or more times within three months.

The researchers noted that colorectal surgery is associated with high readmission rates because of the location on the body and complexity of the operations. Nearly 19 percent of patients developed a surgical-site infection within 30 days of their operation. Two other common reasons for readmission after this type of surgery: dehydration and complications associated with a stoma (a skin opening from a procedure to divert the intestinal tract outside the body).

The study's authors pointed out that reducing surgical-site infections by just 5 percent could dramatically lower readmission rates. They noted that hospitals are already taking preventive steps, including having nurses review patient discharge plans and following up with patients after discharge.

The researchers said that readmission rates for colorectal surgery is an area that calls for cost reduction as well as higher quality of care.

"Hospital readmissions are being used as a surrogate measure for determining quality of care," Wick said. "If care isn't as good, patients end up back in the hospital. We need to make sure patients don't have to come back."

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